The disclosures herein relate generally to orthopedic surgical instruments and more particularly to a method and apparatus for preparing a tibial bone for implantation of a tibial prosthesis.
In operating rooms, space is a valuable asset, and in most operating rooms, space is very limited. The more surgical instruments required for a procedure, the more space required to lay them out with their cases. Costs associated with the time spent in the operating room are very high. Any means, whether by instrumentation and/or technique to help eliminate operating room time would be desirable. There are numerous instrumentation systems from numerous orthopedic suppliers available for tibia preparation dependent on the style of implant. Other systems offer similar looking devices that are used individually for tibia preparation.
For example, U.S. Pat. No. 5,609,642 discloses a method of implanting a femoral and tibial knee prosthesis and instruments for surgically implanting the femoral and tibial prosthesis component. The method includes the formation of a plurality of surgical cuts on the patient's distal femur. A trial femoral prosthesis is then fitted to the surgically prepared distal femur. The trial prosthesis has a femoral articulating surface and a non-articulating surface that fits the patient's distal femur at the surgical cuts. A surgeon then forms a transverse cut on the patient's proximal tibia. The surgeon places a tibial trial prosthesis on the patient's proximal tibia, the trial prosthesis includes a tibial trial stem that fits the patient's intramedullary canal, a tibial trial metallic tray or plate, and a plastic trial insert that fits the tibial tray or plate. The plastic insert includes a tibial articulating surface that can articulate with the femoral articulating surface. The respective articulating surfaces are placed in contact and the surgeon then moves the patient's knee through a full range of motion. During this movement of patient's knee through a full range of motion, the surgeon uses a lever that is attached to the trial tibial prosthesis to rotate the trial tibial prosthesis about its stem. The surgeon can try different rotational positions of the tibial trial prosthesis each time moving the knee through a full range of motion to ensure proper orientation and an accurate fit.
In U.S. Pat. No. 5,690,636, a punch system is provided for preparing a keel cavity in a tibial bone for implantation of a prosthesis. The system provides a modular punch system providing a logical step-by-step approach to cutting, punching, and/or forming the tibial bone. The system includes a quick release punch guide for attaching to a tibial tray trial component of a surgical instrument system for implanting artificial knees, and a universal quick release handle for attaching or detaching a punch from a handle or slap hammer.
In a typical procedure, once the tibia plateau has been cut, a sizing template is used to determine the correct implant size and positioning. Pin holes may be drilled and filled with pins to hold the template in position. The sizing template may then be used as a base for a reamer/broach guide to prepare the canal for the implant stem. Additional pin holes may be drilled for use with the reamer/broach guide. Typical systems also require an individual reamer/broach guide for each size template, stem or baseplate implant used. Depending on the number of sizes offered, this usually amounts to a comparable number of individual instruments. Typically, the template is then removed and a trial tibia baseplate is then placed onto the prepared bone. There are usually individual trials for each size implant offered, which adds additional instruments to the system.
Therefore, what is needed is a method and apparatus for preparing a tibial bone for implementation of a tibial prosthesis which reduces the number of tibial preparation instruments required, and also reduces the overall time for the procedure thereby resulting in reduced operating room time.